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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www,evereltwa.org <br /> y � �i p�, r ;� v ;���.�� <br /> PROJECTADDRESS <br /> I L� ! >� s G�"" �v,h � Y'1�l 4LS 1S;`�v r <br /> 7J fj'L d'1 �N`'�`✓ y-�Y � SlatelZ�p Phona <br /> Owner <br /> MaA Address City <br /> Mail Addrese Ciry <br /> Stele2ip Phone <br /> 7enent <br /> C �' l� w.t( 2�b"1c.3 v�t 1S�s' s14�? <br /> �J� LIc G�i.� �LG/� 7 � ST��, Ei �. . Phona <br /> Electrical Conlraclor Mril AdJress <br /> City Stale2ip <br /> � « <br /> r� � L .�' O�Z t`T Z Contract Prlce oi Wark <br /> Stata License Number <br /> �D�,,yc� — Contacl Person (Plan Review) <br /> Proposed Use oi Building <br /> _____—.—. <br /> Square Footage(If residential new construclion, remodel or addition) <br /> Number of devices(If low voflage) <br /> �" � i-� .� � �S <br /> Uescription of Work lo Be Cone: ° ��—'r�--��t <br /> � <br /> I — <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 5O� <br /> I hQreby certily thaf!have read and oxamined this applicnfion and know fhe same fo be true and <br /> � corroct All provisions o/laws and ordinances goveming this fypo o/worlc will be comploted <br /> I whother spocdied horein or noG The yranfing o/a permif do�s not prasume fo give authonty to PERMIT# <br /> I violato or cancel fbo provisions o/any othersfuto orlocullaw regulating consfn�ction orfhe r I �I O '' � � 7 <br /> I performance o/cons6ucfion. That I am aufhorizoA 6y the owner ol this property to peAorm the <br /> C (� <br /> work lor which npplicafion is mado and 1 comply witb tho State Confracfors Low 18.27 RC6V ond <br /> 296.200 WAC. ,� <br /> �'�, � �v-drJ-1v<� <br /> i,.r>�t-.-�. �L"� f Data <br /> — Signaturc �.,-� <br /> krv�..�n naw» <br /> ---- -�--------- <br />